Healthcare-related identity fraud is on the rise in the United States. The 2025 National Health Care Fraud Takedown found over $10.6 billion in fraudulent claims from more than one million stolen identities across all 50 states.
With this increasing potential for abuse, healthcare identity verification is more important than ever for patients, providers, and insurers to securely navigate modern telehealth channels. Whether it’s intentional or not, aiding fraudulent insurance claims can land your organization stiff penalties, making identity validation key to regulatory compliance.
Luckily, identity verification in healthcare is also becoming more secure, accessible, and reliable. Below, we unpack the logistics of healthcare identity verification, explain its importance, and lay out its key challenges, as well as best practices.
What Is Healthcare Identity Verification?
Identity verification in healthcare is the process of ensuring a patient, insurer, provider, or other party is who they claim to be. In person, this may be as simple as checking one’s identification—but, on digital platforms, it becomes significantly more complicated.
In most cases, you can’t securely check physical IDs over digital systems. As such, electronic identity verification relies on:
- Digital challenges, such as passwords or usage codes
- Secure online servers
- Registered, verified accounts that only the approved individual can access
These and similar methods make impersonating patients more difficult, as fraudsters need access to sufficient personal information to assume their identities.
Identity fraud is a concern for providers as well. Malicious actors may pose as providers to steal patient health data, payment information, or other sensitive details.
Since identity fraud has become so sophisticated and commonplace, identity verification within healthcare organizations has become a cross-departmental duty that falls on:
- Information Technology (IT) workers, who code, refine, and maintain verification portals and authentication methods.
- Compliance professionals, who ensure that digital systems and their usage meet regulatory guidelines.
- Patient access teams, who help patients utilize verification systems and fulfill their healthcare needs.
The essential work these teams do not only improves security for patients and providers but also limits data breaches, identity theft, and other forms of healthcare fraud.
Why Identity Verification Is Essential in Today’s Healthcare Landscape
Identity verification is essential in modern healthcare due to a number of reasons.
- Data breaches and identity theft – A single healthcare-related data breach in 2024 leaked the personal information of over 100 million Americans. Aside from using these identities for fraudulent insurance claims, malicious actors can also impersonate victims to access their bank accounts, apply for credit cards, or take out loans.
- Tightening regulatory standards – While the Health Insurance Portability and Accountability Act (HIPAA) doesn’t mandate any specific authentication methods, it does require providers to verify patients’ identities before sharing medical information. Companion legislation, the Health Information Technology for Economic and Clinical Health (HITECH) Act, outlines an organization’s punishments and reparative actions should they suffer a data breach.
- Expanding telehealth and remote access systems – Three-quarters of physicians work in clinics that offer telehealth services, while nine in ten hospitals utilize similar programs. These providers possess the same types of credentialing as traditional clinics, but offer more accessible services. Telehealth is convenient, and remote access can help patients get quality care more quickly—as long as verification remains reliable.
Ultimately, digital medicine platforms are here to stay. This means that healthcare organizations and hospitals need to adopt identity verification methods that ensure secure authentication.
Key Components of Effective Identity Verification
The most secure healthcare identity verification processes leverage components like multi-factor authentication, biometrics, digital IDs, and more.
Multi-Factor Authentication (MFA)
Multi-factor authentication (MFA) is when login portals utilize two or more challenges before granting a user access to the platform. This can include any combination of these or other methods:
- Usernames and passwords
- Passkeys
- One-Time Passwords (OTPs) sent to phone numbers or emails
- Authenticator apps
Adding multiple layers of security makes fraudulently accessing health information significantly more difficult. Since most medical data is Protected Health Information (PHI), extra safeguards are necessary to prevent sensitive details from falling into the wrong hands.
Biometric and Digital ID Technologies
Modern tools improve verification accuracy with biometrics like:
- Face scans
- Fingerprint readers
These technologies are difficult to bypass or fool, enhancing security for patients who use them.
Digital ID technologies also use a variety of factors—such as biometric markers, passwords, and security certificates—to determine a patient’s identity. Digital IDs are so convenient and secure that they’re trusted up to the highest levels of government: The Centers for Medicare and Medicaid Services (CMS) is currently in the process of implementing them for Medicare users.
Provider Identity Management
Provider identity management systems protect access to patient records and other PHI. Provider identity management is a branch of Identity Access and Management (IAM) that ensures:
- The right healthcare professionals, providers, and other parties have access to the information they need to provide proper patient care.
- Information access is limited to the data the user needs for their duties, rather than patients’ entire records.
- Unauthorized parties can’t access patient data.
IAM not only controls which organizations access records; it also reviews provider credentialing to ensure only authorized individuals within those organizations see sensitive information. In other words, IAM discerns between credentialing vs privileging, so access is tied to both qualifications and approval to work with specific patients and data.
Patient Identity Validation
Properly identifying patients prior to medical appointments ensures practitioners have the right records to inform their services, increasing safety during care delivery. Identification not only helps providers better treat their patients, but it also maintains an unbroken medical record as the attending physician makes their notes in the right place.
As important as identity validation is, however, there are several key challenges to identifying patients, providers, and other parties involved in administering healthcare services.
Common Identity Verification Challenges
The most prevalent challenges with identity verification healthcare organizations face include:
- Outdated verification systems – Telehealth systems have been around for decades, but authentication methods like MFA, digital IDs, and biometrics are all relatively new technologies. Older platforms often don’t support these more recent, more secure verification methods, making them both inconvenient and vulnerable.
- Integration issues across Electronic Health Record (EHR) and access platforms – While EHRs may be stored in one platform, their access may be managed by an entirely different service. Poor integration between these two disparate systems can slow authentication, lock providers out of records, and affect the quality of care.
- Balancing security with user experience – Identity verification platforms need to be secure, but they also need to be intuitive and usable by the vast majority of the population. Striking the proper balance between safe authentication procedures and user experience (UX) can be challenging and may require several reworks to get right.
While these issues make identity verification in healthcare more complex, employing the right practices can simplify authentication while still maintaining patient and provider security.
Best Practices for Strengthening Identity Verification
To establish strong, secure identity verification processes in your organization, follow these best practices:
- Adopt advanced verification technologies – Secure, modern verification methods—like digital IDs, biometrics, and MFA—are more difficult to crack than older, simpler authentication techniques like usernames and passwords.
- Implement identity governance policies – Manage which identities can access key information for both internal and external users. Limit access to strictly mandatory data to uphold privacy regulations and protect sensitive information.
- Regularly audit access permissions and data use – Routinely check your granted permissions so inactive users, past employees, and other unapproved parties can’t access sensitive data. Similarly, monitor how your team uses and shares data to ensure they’re maintaining your organization’s regulatory compliance.
Ultimately, identity verification is essential. But it’s also complex. Instead of handling it alone and risking breaches and fines, partner with a reliable verification specialist to prevent penalties and safeguard patient trust.
Safeguarding Trust in the Digital Health Era
Healthcare identity verification ensures patients, providers, and other partners are who they claim to be. Secure identity authentication processes mitigate healthcare credentialing issues with reliable healthcare license verification, provide trustworthy links between patients and providers, and safeguard sensitive data from malicious actors.
When seeking out verification systems, choose a secure, scalable solution to protect your data and grow alongside your organization. Verisys’s proven validation techniques help healthcare organizations establish secure connections with patients and partners.
From healthcare compliance monitoring to healthcare background screening and workforce management for healthcare record access, we simplify verification to make telehealth more secure for everyone.
Sources:
United States Department of Justice. National Health Care Fraud Takedown Results in 324 Defendants Charged in Connection with Over $14.6 Billion in Alleged Fraud. https://www.justice.gov/opa/pr/national-health-care-fraud-takedown-results-324-defendants-charged-connection-over-146.
United States Department of Health and Human Services. Fraud & Abuse Laws. https://oig.hhs.gov/compliance/physician-education/fraud-abuse-laws/.
Journal of the American Medical Association. Ransomware Attacks and Data Breaches in US Health Care Systems. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2833984.
United States Department of Health and Human Services. Individuals’ Right under HIPAA to Access their Health Information 45 CFR § 164.524. https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/access/index.html.
United States Department of Health and Human Services. Summary of the HIPAA Security Rule. https://www.hhs.gov/hipaa/for-professionals/security/laws-regulations/index.html.
American Medical Association. 74% of physicians work in practices that offer telehealth. https://www.ama-assn.org/practice-management/digital-health/74-physicians-work-practices-offer-telehealth.
American Hospital Association. Fact Sheet: Telehealth. https://www.aha.org/fact-sheets/2025-02-07-fact-sheet-telehealth.
Centers for Medicare and Medicaid Services. White House, Tech Leaders Commit to Create Patient-Centric Healthcare Ecosystem. https://www.cms.gov/newsroom/press-releases/white-house-tech-leaders-commit-create-patient-centric-healthcare-ecosystem.
The HIPAA Journal. The Importance of Identity and Access Management (IAM) in Healthcare. https://www.hipaajournal.com/identity-access-management-iam-healthcare/.
National Library of Medicine. 3. The Evolution of Telehealth: Where Have We Been and Where Are We Going?. https://www.ncbi.nlm.nih.gov/books/NBK207141/,
